BY VICTOR S. SIERPINA, MD, ABFM, ABIHM, Director, Medical Student Education Program, WD and Laura Nell Nicholson Family Professor of Integrative Medicine, Professor, Family Medicine University of Texas Distinguished Teaching Professor
As Chiron rowed passengers across the river Styx,
So too does Death do his job, so similarly
Visiting people, unbiased, unprejudiced,
Without a word, without complaint, as he is
greeted back with adversity.
Not always is Death greeted in such a way.
Some welcome him, wait for him
seeking for his comfort.
They take his hand in such gratitude,
Death for his solace,
his quiet calming
presence he brings.
This is an excerpt from a poem, The Inevitable Visitor, which was written by one of the medical students in my small group as part of UTMB’s Physician Healer Track. Students in this track are regularly given assignments that call for reflective essays. In this case, an experience in neonatal hospice inspired the poem. The student’s talent for writing is clear, as is his ability to step back and take an artist’s view of the topic of death.
This is just one brief example of the kind of depth students plunge into during this fouryear track. The Physician Healer Track was conceived by Drs. Cara Geary, Julie McKee, Susie Gerik, Lee Grumbles, and Era Buck at UTMB—Health’s School of Medicine. It is supported by the efforts of more than a dozen other dedicated volunteer faculty educators. The track is an innovative educational program designed among other things to diminish the historic welldocumented decline in students’ empathy over their medical school training as well as to decrease burnout.
The structure and content of the track are as follows. Students meet with faculty once monthly over dinner for faculty facilitated group discussions during their first two years. Prior to the dinner session they complete assigned readings, are encouraged to engage in self-reflection and write a reflective essay. These sessions focus on topics meant to spur improved self-awareness, communication skills, professional identity formation, and an integrative approach to patient care.
Throughout the first and second years, they are progressively introduced to deeper self-awareness through a variety of psychological tools such as the Myers-Briggs and Enneagram. They journal as they learn the tools of Cognitive Behavioral Therapy and Rational Emotive Based Therapy and how to apply these to their own lives and ultimately to their patient care. They read about and practice Non-Violent Communication, cultivate stress resilience, learn the difference between empathy and compassion, discover the practice of selfcompassion, cultivate gratitude, and come to appreciate the role of humor in medicine. Assignments are geared to take two to three hours of work. The course is not graded beyond pass or fail though students will have a notation on graduation of having completed this track.
A required part of the track is an intensive two-month preceptorship, half clinical, half didactic between years one and two. During this period, they learn to practice mindfulness, develop improved self-care in terms of stress management, nutrition, and exercise, practice breaking bad news, discover how to approach patients in pain from a psycho-spiritual perspective, and join at the bedside to discover how to be with someone in a vegetative, altered mental status condition. They are also assigned to read pertinent books, journal articles, and view and discuss selected films. They learn and practice the important basic tools of motivational interviewing, spend interprofessional time with hospice volunteers, chaplains, and nurses. Students write daily in a personal journal on their reflections, examine and discuss their own feelings, and identify their own strengths, weakness, and biases. They conclude with a five-page essay reflecting on their experience in the PHT and also create a digital story/video which are shared with faculty.
Students’ essays and surveys of their experiences show high enthusiasm for the program including their endorsing the acquisition of specific skills in collaborative practice, empathy, ability to cope with the stresses of medical school, and enhanced personal and professional development.
Now in its third year, we have had roughly two dozen students per class and expect to enroll as many as three dozen first-year students in the upcoming year. Students in their third year will continue with the same faculty facilitators in the highly popular Practice of Medicine 3 course that covers topics not otherwise covered in their first two years but that come up in their clinical years such as ethical, social, financial, and moral challenges. Physician Healer Track students will also have additional assignments building on the clinical relevance of what they have learned in the first two years. The Practice of Medicine 4 will further build on an existing program and help internalize skills the students have acquired in PHT over the preceding three years.
We continue to gather qualitative and quantitative data on the outcome of this innovation in education and are optimistic that this new generation of healers will emerged from medical school with their empathic skills not only intact but stronger, their ability to communicate, to motivate, to share with their patients enhanced by their heightened understanding of themselves, improved mindfulness, and self-care. Their resilience to stress will help them lead their peers and patients to a new kind of personalized, patient-centered, integrative, and holistic medical care of the future.